Anda di halaman 1dari 1

on inspection

oedematous

congested
mass Thrombosed
purplish

seen @ the anal margin

digital rectal exam - VERY PAINFUL ! tight spasm of the anal sphincter
Both thrombosed and strangulated present with acute
pain
even more painful

necrotic
can become mass
ulcerated Strangulated Acute Presentations

several days of bed rest


symptomatic relief
ice packs sering terjadi
application of
topical anaesthetic gel setengah populasi dunia ada mengalami keluhan
slightly higher risk of complications hemoroid
Introduction sangat sering
more rapid return to normal life
Men mengalamil
Surgeons prefer for urgent haemorrhoidectomy periode panjang
prophylactic antibiotics
Gender Differences
late pregnancy
generally shorter
Women rentan
hospital stay and recovery period
Subtopic 2 puerperium

avoiding constipation most important means of prevention pregnancy

diet high in fibre heredity predisposition constipation

pt advised to always heed the call to evacuate diarrhoea


best achieved by
kemungkinan penyebab
avoid straining
pt strongly encouraged to
spend minimal time defaecating
feses yang keras
prolonged ritual leads to furth...

leads to the formation of a solitary ulcer Conservative Management and meningkatkan tekanan abdomen
repititive straining
posterior wall of of the proximal anal canal Prevention of Haemorrhoids
symptoms can often be relieved by the patient obstruksi venous return
replacing the prolapsing haemorrhoids digitally after
defaecation 3rd degree haemorrhoids
plexus vena menjadi membesar
useful as temporary measure

do nothing to treat the underlying condition creams Pathogenesis mukosa bulging lalu dibawa oleh feses yg keras ke arah
may even cause local allergic reactions distal
contain local anaesthetic agents or steroids suppositories treatment
arteri characteristic bright red rectal bleeding
maceration of the perianal skin topical preparations bleed
overuse venous component causes problem ONLY if it becomes thrombosed thrombosed external venous saccule
predisposes to secondary infection
Haemorrhoids may prolapse

mucus
dietary change cause slight leakage
do not regress by 1st degree which faecal
avoiding straining particularl...
which?
most 2nd degree
Haemorrhoids When viewed
supine
position
what?  Injection of Sclerosants lithotomy

outpatient basis 3
Located at
does not require any anaesthetic Sclerotherapy 7 o'clock positions
how?  11
to obliterate the haemorrhoidal vessels

How?  1st never prolapse


unbearably painful not placed around the stalk application of rubber bands Banding prolapse through defaecation
Surgical Treatment degree 2nd
somatic innerva...
return sponaneously into the anal canal
acco...
haemorrhoid gradually shrinks Result 3rd remain outside the anal margin unless replaced digitally
indicated for 3rd degree haemorrhoids Kebanyakan hemoroid dapat digambarkan sebagai
secondary intention
Classification internal karena mereka ditutupi oleh glandular mukosa
heal by skin & mucosal defects leaves Milligan and Morgan  operation most commonly performed Large neglected haemorrhoids may extend beneath the
wound contraction
open operation stratified squmaous epithelium so that their lower part intero-external piles
becomes covered by skin
large grade II
gained popularity for Haemorrhoidectomy
grade III
intermittent symptoms
mucosal prolapse
attacks last from a few days to a few weeks
excising an entire ring of low rectal mucosa
aims to restore the anatomy of the anal cushions precipitating factor episodes of constipation
including the engorged neck of the piles
Stapled Haemorrhoidectomy bleeding stool trauma
when compared to
less painful & gives equivalent results prolapse large haemorrhoids then thrombose
stool softeners small skin tags
Before Operation
gentle laxatives perianal irritation

caudal analgesia Painful Early Period Post-Operative Itching(pruritus ani)

on the paper
rectal bleeding
acutely painful Symptoms and Signs common chronic or intermittent seperate from the stool
sudden haemorrhoidal prolapse
persistent pain lasting 1-2 weeks mucus leakage
if untreated onset imperfect closure of anal cushions
worse on defaecation Mild incontinence of flatus
blue-black hemispherical bulge on examination essential
near anal margin Thrombosed External Haemorrhoids Digital Examination exclude carcinoma
subside over a few days useful measure of anal tone
patients need only oral analgesia Proctoscopy demostrate internal piles
most
thrombosis may be incised and drained under local seen bulging into the l...
Investigation
anaesthesia
important in patient over 40 years
Subtopic 4 Sigmoidoscopy
occassionally rectal polyp is diagnosed this way

Anda mungkin juga menyukai